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Clostridium difficile infection: an update on epidemiology, risk factors, and therapeutic options

Lo Vecchio, Andreaa; Zacur, George M.b

Current Opinion in Gastroenterology: January 2012 - Volume 28 - Issue 1 - p 1–9
doi: 10.1097/MOG.0b013e32834bc9a9

Purpose of review The incidence and severity of Clostridium difficile infection (CDI) around the world has increased over the past 20 years due to the emergence of hypervirulent strains, increased use and misuse of antibiotics, and the increase of susceptible at-risk populations. Treatments currently available for CDI are inadequate to impede the increasing spread and virulence of the infection, avoid recurrence in chronic patients or prevent infection in at-risk populations.

Recent findings New and promising evidence has been presented during the past year, focusing on two major points: preservation of gut microflora and optimization of immune response to CDI and toxins.

Summary The review aims to summarize the most recent evidence available on the epidemiology, risk factors and treatment of CDI. New antibiotics with selected action on C. difficile and limited effect on microflora (fidaxomicin) and donor fecal transplantation seem to have a relevant efficacy in treating CDI and reducing its recurrence. The use of selected monoclonal antibodies directed against C. difficile toxins in addition to standard therapy is a new, promising approach for the treatment of recurrent cases. Vaccination could be an additional weapon against CDI. New robust data are needed before recommendations can be made to abandon current treatment based on vancomycin and metronidazole and move toward new frontiers.

aDivision of Pediatric Infectious Diseases, Department of Pediatrics, University of Naples ‘Federico II’, Naples, Italy

bDivision of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

Correspondence to Andrea Lo Vecchio, MD, Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Naples ‘Federico II’, 80128 Naples, Italy. Tel/fax: +39 081 7464232; e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.